Provider Demographics
NPI:1225214182
Name:MEDIGYNE ASSOCIATES CH
Entity Type:Organization
Organization Name:MEDIGYNE ASSOCIATES CH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:DERUITER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-747-4963
Mailing Address - Street 1:2202 STATE AVE STE 311
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-4590
Mailing Address - Country:US
Mailing Address - Phone:850-747-4963
Mailing Address - Fax:850-747-0074
Practice Address - Street 1:2202 STATE AVE STE 311
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4590
Practice Address - Country:US
Practice Address - Phone:850-747-4963
Practice Address - Fax:850-747-0074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-10
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0012877207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL066314000Medicaid
FLD56481Medicare UPIN
FL066314000Medicaid